Marlene Bryenton spent a year hoping for a miracle.
She hoped her son, homeless in Ontario, would return home to Prince Edward Island and get the treatment he needs for his mental illness.
In November, a miracle happened. Bryenton’s son is receiving hospital care in Prince Edward Island and improving, she says.
But she is worried he will stop his medications once discharged. One of the symptoms of his illness is that he does not understand he has an illness and needs treatment, she says.
Bryenton is afraid he will become homeless again — and that PEI’s new Mental Health Act will not help him.
Last month, Prince Edward Island became the final Canadian jurisdiction to pass legislation creating community treatment orders. These orders are legal agreements that require someone with a severe mental illness, who does not understand they have an illness and needs medication, to continue their treatment plan after leaving the hospital. That may include regular doctor’s appointments and taking medications at prescribed times. The goal is to keep people in the community, not in the hospital.
If someone does not follow the treatment plan, police can take them to the hospital for treatment.
Substitute decision makers can agree to the order for those who cannot consent. Patients can appeal the order if they think they should not have one.
Too restrictive
PEI’s Mental Health Act received royal assent November 29 and will come into force by May 29.
But Bryenton does not know if her son is eligible for a community treatment order.
The new law says a patient is eligible if they have had two or more involuntary hospitalizations in a psychiatric unit during the past two years. Combined, these hospitalizations must equal at least 30 days. It’s a narrow definition of what qualifies. For example, if someone had four one-week admissions, they would not qualify.
Bryenton’s son was in a Toronto hospital before being moved to Charlottetown. His stays in the two provinces combined are longer than the required 30 days. But Bryenton does not know if the Ontario hospitalization counts. She says her son’s doctor said it will count; specialists she has asked said it will not.
The PEI government did not respond to an email asking if out-of-province hospitalizations are considered when determining if someone is eligible for a community treatment order.
The health minister plans to review the law in 24 months “and is open to making any amendments deemed necessary at that time,” according to a statement by the provincial department of health and wellness.
Some experts say PEI’s law is too restrictive and could force people to go to the hospital when they could be treated in the community.
Dr. Richard O’Reilly, a psychiatrist in London, Ontario and professor at Western University, called PEI’s community treatment law Canada’s “most restrictive.”
O’Reilly, who has been a doctor for more than 40 years, says he has seen many people improve as a result of community treatment orders. Their illness does not go away, but they learn to manage it.
Care is “overall better if it’s possible and appropriate to treat somebody in the community,” he said. It keeps people from being admitted for short hospital stays that are not long enough for them to become stable. And it allows people to be close to friends and family. “It’s less restrictive for the person.”
John Gray, a retired psychologist and lead author of the book Canadian Mental Health Law and Policy, agrees. A person who does not qualify for a community treatment order in PEI could qualify elsewhere in Canada. In Ontario, someone qualifies if they have had two or more hospitalizations within the previous three years or if they have been hospitalized for at least 30 days. PEI requires both, a specific number of hospitalizations and at least 30 days in hospital.
Families often advocate for community treatment orders because they have watched their relatives’ health decline, says Gray.
‘Many roadblocks’
Bryenton knows well the disruption mental illness can cause.
For years, she watched her son’s health decline. He was first diagnosed and treated in hospital a little more than six years ago. He stopped taking his medication shortly after being discharged.
In October 2022, he decided to move to Halifax. In January 2023, his parents heard he was in Moncton. Then they heard he was in Toronto. He lived on Toronto’s streets from January to October. Eventually, he was admitted to the hospital.
After much lobbying from Bryenton, PEI’s Minister of Health signed an order authorizing her son to be moved to a hospital in Charlottetown. He traveled by air ambulance to Charlottetown accompanied by medical staff.
Her son could have been homeless if the minister had not signed that order, Bryenton says. The hospital could have discharged him, and he would have been on the streets again.
He arrived in Charlottetown on November 9.
“We have climbed over so many roadblocks this last year,” Bryenton said. When her son was homeless, she contacted Facebook community groups in Ontario asking them to help him. She would spend 10 hours a day responding to information about his whereabouts.
She started a petition asking the government to change the law to make it more like New Brunswick’s. In New Brunswick, someone does not have to have been admitted to the hospital for a community treatment order to be issued. Instead, a person is eligible if a psychiatrist is convinced that they have a serious and continuous mental illness that limits their function and requires care and treatment.
As of December 15, the petition had 1,459 signatures, primarily from Ontario and PEI residents.
The Ontario people who signed “feel that they have a vested interest,” Bryenton said. “They took care of him all the time.”
‘Tool in the toolkit’
Not everyone thinks community treatment orders are good.
Archie Kaiser, a law professor at Dalhousie University in Halifax, says they are an “obvious…infringement on basic civil liberties” for people with mental illnesses. People should not be forced to consent to treatment so they can leave the hospital, he said. They should voluntarily agree to community supports and be able to decide to stop treatments. The orders will work better “if people accept the help being offered to them instead of it being forced upon them,” he said.
But David Gratzer, a psychiatrist at the Centre for Addiction and Mental Health in Toronto, says he considers community treatment orders not as intrusive into patient’s rights as some people say. The orders are actually not very common, although he says he has used them for patients.
“It’s a tool in the toolkit of psychiatrists to help keep people who have severe, persistent mental illness out of hospital and in the community,” he said.
Bryenton hopes her son returns to his regular life on PEI. His athletic abilities, his career, his friends have “been stripped away,” she said. “He’s going to have to start all over again.”
Ultimately, Bryenton wants Islanders with mental illness to have the best care possible.
“They have a life,” she said. “They deserve being well, instead of this continuous revolving door, in and out, in and out of hospital.”
Thank you for taking an interest in our son’s story, Meagan. I am hoping that his story will raise much mental health awareness. It is a very painful story and one that we will never forget.
Our battle continues with the P.E.I. Government to amend the legislated WORST IN CANADA Community Treatment Order. Minister of Health and Wellness Mark McLane said he willing to make necessary changes after 24 months.
I do not feel that this is acceptable, as there are many Islanders that will not qualify for a Community Treatment Order, as it is so restrictive. In some cases, this could be a life or death situation. I feel that Islanders need and deserve the BEST CTO IN CANADA.
It is now my mission to lobby the P.E.I. Government to amend the CTO in the 2024 spring session. The BEST IN CANADA CTO belongs to New Brunswick. I am encouraging the P.E.I. Government to cut and paste the N.B. CTO model. Failing that, insert the “OR” word which would qualify more Islanders. The CTO would then read, ” two admissions or 30 days.”
The following is part of a document that I sent to the P.E.I. Government decision makers PRIOR to the CTO legislation. It is authored by Dr. Richard O’Reilly, psychiatrist for 40 years, emeritus professor of psychiatry at Western University, London, Ontario and Dr. John Gray, a retired psychologist and lead author of the book Canadian Mental Health Law and Policy, Vancouver, B.C.
The document was titled EVOLUTION AND COMPARISONS. It compared the Prince Edward Island CTO to the New Brunswick CTO..
COMPARISONS P.E.I. CTO TO N.B. CTO:
1. Previous hospitalization:
P.E.I.: at least 2 involuntary admissions AND a total of 30 days as involuntary inpatient.
N.B. 1 admission of any duration OR none if there is a “pattern of behaviour” that is likely to cause serious harm or deterioration. Alberta has a similar provision to N.B.
Example: A person could be admitted to a P.E.I. hospital four times for seven days each and still NOT QUALIFY for a P.E.I. CTO.
Wishing everyone at Canadian Affairs a very Merry Christmas and Happy New Year!